Fairfax Periodontal and Implant Center, PLLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

FAIRFAX PERIODONTAL AND IMPLANT CENTER, PLLC

Practice address

8622 Route 29 Ste D
Fairfax, VA 22031-2148

Phone

(703) 491-2974

NPI assigned

Oct 24, 2023

Last updated

Oct 24, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ahmad Hawasli, DDSNPI 1508263104

Title

Owner/Dentist

Phone

(703) 491-2974

Specialties & licenses 1

Addresses

Other names 1

• Woodbridge Periodontal and Implant Center Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ahmad Hawasli

  • Periodontics
  • Manassas, VA
  • NPI 1508263104
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1932971850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8622 ROUTE 29 STE D",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312148",
            "telephone_number": "703-491-2974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8622 ROUTE 29 STE D",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312148",
            "telephone_number": "703-491-2974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX PERIODONTAL AND IMPLANT CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-24",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "HAWASLI",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "703-491-2974",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodbridge Periodontal and Implant Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Periodontics in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Periodontics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.